Possible treatment option for the right patient; but further research needed
ROSEMONT, Ill., June 6, 2013 /PRNewswire-USNewswire/ -- Most aging adults will
experience back pain or a spinal disorder at some time in their life. In fact,
about 25.8 million visits were made to physicians' offices due to primary back
problems. Treatment focuses on pain relief and is available in both non-surgical
(medication or physical therapy) and surgical forms.
A retrospective study in the June 5th issue of the Journal of Bone and Joint
Surgery (JBJS) looked at one type of back treatment - a lumbar epidural steroid
injection (LESI) - and whether or not that treatment had an impact on bone
fragility and vertebral fractures (spinal fractures). A higher number of
injections was associated with increased risk. Authors concluded that LESIs may
lead to increased bone fragility over time, and while injection therapy is
useful in some cases, it should be approached cautiously for patients at risk
for fractures associated with osteoporosis.
Patients at a high risk for vertebral fractures after an epidural injection
include older women, those who have had an earlier fracture, those who smoke and
those who are underweight. Young and active male patients have a lower risk of
"In the appropriate setting, and for the right patient, LESI provides effective
symptomatic relief and improved level of function," said Shlomo Mandel, MD, MPH,
lead author of the JBJS study and orthopaedic surgeon at Henry Ford Health
System. "Through careful screening and monitoring steroid exposure, the risk of
a fracture can be minimized. As orthopaedic surgeons who specialize in spine, we
know there is a role for injection therapy, but the challenge is to make sure it
is administered safely and still provide long-term benefits."
Study Details and Key Findings:
-- Authors identified a total of 50,345 patients who had medical diagnosis
codes involving the spine and from that group, a total of 3,415 patients
had received at least one LESI.
-- 3,000 patients were randomly selected from the 3,415 injected
population, and then 3,000 patients from the non-injected group were
selected as a control group. The incidence of vertebral fractures was
-- There was no significant difference between the injected and
non-injected groups with respect to age, sex, race, hyperthyroidism, or
-- An increasing number of injections were associated with an increasing
likelihood of fractures, and each successive injection increased the
risk of spinal fracture by 21 percent.
"It's important to remember that when contemplating an epidural steroid
injection a physician should have a symptomatic history, physical findings and
corresponding imaging of direct pressure on a single nerve," added Dr. Mandel.
"Together with our patient, we review the benefits and risks of alternative
treatments before selecting an epidural steroid injection."
Dr. Mandel and his co-authors agree that more research is warranted on this
relationship. They have a prospective study on vertebral fractures and injection
therapy in the works.
June 5, 2013 JBJS Full Table of Contents
-- A Retrospective Analysis of Vertebral Body Fractures following Epidural
-- Time to Failure After Rotator Cuff Repair: A Prospective Imaging Study
-- It a sprint or a marathon? When is the arthroscopic rotator cuff repair
at risk to lose the race for healing?
-- Prognosis for congenital scoliosis due to a unilateral failure of
-- The use of an Anti-Fibrotic Agent Improves the Effect of Platelet Rich
Plasma on Muscle Healing after Injury
-- Platelet-rich plasma a la carte
-- The influence of the contralateral knee prior to knee replacement on
post-knee replacement function: The Multicenter Osteoarthritis Study
-- Impaction Grafting in Revision Total Elbow Arthroplasty for Aseptic
Loosening and Bone Loss
-- Displacement of the Sustentacular Fragment in Intra-Articular Calcaneal
-- Severe Impingement of Lumbar Disc Arthroplasty Increases the Functional
Biologic Activity of Polyethylene Wear Debris
-- Early Prospective Clinical Results of a Modern Fixed-Bearing Total Ankle
-- Risk Factors for Readmission of Orthopaedic Surgical Patients
-- Beyond the Square Knot: A Novel Knotting Technique for Surgical Use
-- Comorbidities and perioperative complications in HIV-positive patients
undergoing primary total hip and knee arthroplasty
-- Recovery of decreased bone mineral mass after lower limb fractures in
-- Improving the Accuracy of Acetabular Component Orientation: Avoiding
-- Operative Treatment of Osteochondral Lesions of the Talus
-- Reporting and Methodological Quality of Systematic Reviews in the
JBJS, Inc., is a not-for-profit publisher specializing in orthopaedic
information. It publishes the Journal of Bone & Joint Surgery, which has been
the most valued source of information for orthopaedic surgeons and researchers
for over 100 years and is the gold standard in peer-reviewed scientific
information in the field -- a core journal and essential reading for orthopaedic
surgeons worldwide. Other publications include JBJS Case Connector and JBJS
Essential Surgical Techniques.
A Nation in Motion(R)
More than one in four Americans have bone or joint health problems, making them
the greatest cause of lost work days in the U.S. When orthopaedic surgeons
restore mobility and reduce pain, they help people get back to work and to
independent, productive lives. Orthopaedic surgeons provide the best value in
American medicine in both human and economic terms and access to high-quality
orthopaedic care keeps this "Nation in Motion." To learn more, to read hundreds
of patient stories or to submit your own story, visit ANationInMotion.org.
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SOURCE American Academy of Orthopaedic Surgeons